（発明の背景）
本発明は、一般に、医療、外科、および／またはメボット利用デバイスおよびシステムに関する。例示の実施形態では、本発明は、最小侵襲的ロボット利用手術の間に、外科用器具の位置を束縛するオフセット中心マニピュレーターを提供する。(Background of the Invention)
The present invention generally relates to medical, surgical, and / or mebot-based devices and systems. In an exemplary embodiment, the present invention provides an offset center manipulator that constrains the position of the surgical instrument during minimally invasive robotic surgery.
最小侵襲的医療技法は、診断または外科的手順の間に損傷される異質組織の量を低減することが意図され、それによって、患者の回復時間、不快および有害な副作用を低減する。最小侵襲的手術の１つの効果は、例えば、術後入院回復時間が減少されることである。標準的な手術について平均の入院は、代表的には、類似の最小侵襲的手術についての平均の入院より有意に長いので、最小侵襲的技法の増加した使用は、毎年の病院費用において数百万ドルを節約し得る。合衆国で毎年実施される多くの手術は、潜在的に最小侵襲的様式で実施され得るが、現在の手術の一部分のみが、最小侵襲的器具およびこれらをマスターする際に関与するさらなる外科的訓練における制限に起因してこれらの有用な技法を用いているに過ぎない。 Minimally invasive medical techniques are intended to reduce the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort and adverse side effects. One effect of minimally invasive surgery is, for example, a reduction in post-operative hospitalization recovery time. Because the average hospitalization for standard surgery is typically significantly longer than the average hospitalization for similar minimally invasive surgery, the increased use of minimally invasive techniques has resulted in millions of annual hospital costs. You can save dollars. Many operations performed annually in the United States can potentially be performed in a minimally invasive manner, but only a portion of current operations are in minimally invasive instruments and further surgical training involved in mastering them They only use these useful techniques due to limitations.
最小侵襲的ロボット利用手術または遠隔手術システムが、外科医の器用さを増し、そして伝統的な最小侵襲的技法に関するいくつかの制限を避けるために開発されている。遠隔手術では、外科医は、例えば、サーボ機構のような遠隔制御の特定の形態を用い、手によって直接器具を保持し、そして移動することよりも、外科用器具の動きを操作する。遠隔手術シテスムでは、外科医は、外科ワークステーションで手術部位の画像を提供され得る。ディスプレイ上で手術部位の二次元または三次元画像を見ながら、外科医は、マスター制御デバイスを操作することにより、患者に対する手術手順を実施し、これは、次に、サーボ機構によって作動される器具の動きを制御する。 Minimally invasive robotic surgery or telesurgical systems have been developed to increase surgeon dexterity and avoid some limitations on traditional minimally invasive techniques. In telesurgery, the surgeon uses a specific form of remote control, such as a servomechanism, to manipulate the movement of the surgical instrument rather than holding and moving the instrument directly by hand. In the telesurgical system, the surgeon may be provided with an image of the surgical site at the surgical workstation. While viewing a two-dimensional or three-dimensional image of the surgical site on the display, the surgeon performs a surgical procedure on the patient by manipulating the master control device, which in turn is an instrument that is operated by a servomechanism. Control the movement.
遠隔手術のために用いられるサーボ機構は、しばしば、２つのマスターコントローラー（外科医の手の各々のためのもの）からの入力を受け、そして外科用器具が各々取り付けられる２つ以上のロボットアームを含み得る。マスターコントローラーと、関連するロボットアームと、器具アセンブリとの間の作動通信は、代表的には、制御システムを通じて達成される。このコントロールシステムは、代表的には、少なくとも１つのプロセッサーを含み、これは、マスターコントローラーからの入力コマンドを、関連するロボットアームおよび器具アセンブリに、そして例えば、フィードバックなどを行う場合、これら器具およびアームアセンブリから関連するマスターコントローラーに戻してリレーする。ロボット利用外科的システムの１つの例は、Ｍｏｕｎｔａｉｎ Ｖｉｅｗ ＣＡのＩｎｔｕｉｔｉｖｅ Ｓｕｒｇｉｃａｌ，Ｉｎｃ．から入手可能なＤＡ ＶＩＮＣＩ（登録商標）システムである。 Servo mechanisms used for telesurgery often include two or more robotic arms that receive input from two master controllers (for each of the surgeon's hands) and each is attached to a surgical instrument. obtain. Operational communication between the master controller, the associated robot arm, and the instrument assembly is typically accomplished through a control system. The control system typically includes at least one processor, which receives input commands from the master controller to the associated robot arm and instrument assembly and, for example, when providing feedback, these instruments and arms. Relay from the assembly back to the associated master controller. One example of a robotic surgical system is available from Intuitive Surgical, Inc. of Mountain View CA. DA VINCI® system available from
種々の構造配列が、ロボット利用手術の間の手術部位で外科用器具を支持するために用いられ得る。駆動される連結または「スレーブ」は、しばしば、ロボット利用外科用マニピュレーターと呼ばれ、そして最小侵襲的ロボット利用手術の間にロボット利用外科用マニピュレーターとして使用のための例示の連結配列は、特許文献１、２および３に記載され、これらの完全な開示は、本明細書中に参考として援用される。これらの連結は、しばしば、シャフトを有する器具を保持するために平行四辺形を使用する。このようなマニピュレーター構造は、器具を、この器具が剛直なシャフトの長さに沿って間隔を置かれて位置される球回転の中心の周りで旋回するように束縛し得る。この回転の中心を、内部手術部位への切開点（例えば、腹腔鏡手術の間の腹腔壁でトロカールまたはカニューレによる）と整列することにより、外科用器具のエフェクターが、腹腔壁に対して危険な力を課すことなく、マニピュレーター連結を用いてシャフトの端部を移動することによって安全に位置決めされ得る。代替のマニピュレーター構造は、例えば、特許文献４、５、６、７、８および９に記載され、これらの全体の開示が本明細書中に参考として援用される。 Various structural arrangements can be used to support surgical instruments at the surgical site during robotic surgery. Driven linkages or “slaves” are often referred to as robotic surgical manipulators, and an exemplary linkage arrangement for use as a robotic surgical manipulator during minimally invasive robotic surgery is described in US Pat. 2 and 3, the complete disclosures of which are incorporated herein by reference. These connections often use parallelograms to hold instruments with shafts. Such a manipulator structure may constrain the instrument so that it pivots around the center of sphere rotation that is spaced along the length of the rigid shaft. By aligning this center of rotation with an incision point to the internal surgical site (eg, by a trocar or cannula at the abdominal wall during laparoscopic surgery), the surgical instrument effector is dangerous to the abdominal wall. It can be safely positioned by moving the end of the shaft using a manipulator connection without imposing a force. Alternative manipulator structures are described, for example, in U.S. Patent Nos. 4,5,6, 7, 8, and 9, the entire disclosures of which are incorporated herein by reference.
新たな遠隔手術システムおよびデバイスは、高度に有効および有利であることが照明されているが、なおさらなる改良が所望され得る。一般に、最小侵襲的ロボット利用手術を実施するための改良された構造およびシステムを提供することが所望され得る。より詳細には、これらシステムの使用の効率および容易さを増大することが有利であり得る。例えば、ロボット利用外科用マニピュレーターによって提供される移動の範囲を、同時に、システムの全体の複雑さ、サイズ、および物理的重量を低減しながら改良することが特に有利であり得る。 Although new telesurgical systems and devices have been illuminated to be highly effective and advantageous, still further improvements may be desired. In general, it may be desirable to provide an improved structure and system for performing minimally invasive robotic surgery. More particularly, it may be advantageous to increase the efficiency and ease of use of these systems. For example, it may be particularly advantageous to improve the range of movement provided by a robotic surgical manipulator while simultaneously reducing the overall complexity, size, and physical weight of the system.
（発明の簡単な要旨）
本発明は、一般に、医療、手術、および／またはロボット利用デバイスおよびシステムに関する。特に、本発明は、外科用器具を支持するために用いられる改良された遠隔中心マニピュレーターに関し、そして最小侵襲的ロボット利用手術の間の器具の所望の位置で任意のベアリングまたは機械的支持体から遠隔にある球回転の中心を提供する。この遠隔中心マニピュレーターは、器具が回転の固定された中心の周りで動くように束縛し、これは、好ましくは、患者の腹腔壁のような患者中の侵入切開と一致する。１つの例示の実施形態では、本発明は、オフセット遠隔中心平行四辺形マニピュレーター連結アンセブリを提供し、これは、最小侵襲的ロボット利用手術の間に外科用器具の位置を束縛する。この改良された遠隔中心マニピュレーターは、第１および第２の軸に沿った器具の動きの範囲を有利に増大し、これは、同時に、このロボット利用外科用システムの複雑さ、サイズ、および物理的重量を低減する。このような利点は、次いで、このようなロボット利用外科用システムの使用の効率および容易さを増大する。(Simple Summary of Invention)
The present invention relates generally to medical, surgical, and / or robotic devices and systems. In particular, the present invention relates to an improved remote center manipulator used to support surgical instruments, and remotely from any bearing or mechanical support at the desired location of the instrument during minimally invasive robotic surgery. Provides the center of ball rotation at The remote center manipulator constrains the instrument to move around a fixed center of rotation, which preferably coincides with an invasive incision in the patient, such as the patient's abdominal wall. In one exemplary embodiment, the present invention provides an offset remote center parallelogram manipulator coupled assembly that constrains the position of the surgical instrument during minimally invasive robotic surgery. This improved remote center manipulator advantageously increases the range of instrument movement along the first and second axes, which simultaneously reduces the complexity, size, and physicality of the robotic surgical system. Reduce weight. Such advantages in turn increase the efficiency and ease of use of such robotic surgical systems.
本発明の第１の局面では、外科用器具の位置を束縛するための遠隔中心マニピュレーターが提供される。最小侵襲的ロボット利用手術の間に器具ホルダーに連結可能な外科用器具は、細長いシャフトを含む。このシャフトは、患者の身体壁中の切開を通り、身体腔中への挿入のための形態である遠位作業端部を有する。上記遠隔中心マニピュレーターは、第１の軸の周りの回転のための平行四辺形連結ベースに回転可能に連結された取り付けベースを有する関節連結アセンブリを備える。上記平行四辺形連結ベースは、複数のリンクおよびジョイントによって上記器具ホルダーに連結され。上記リンクおよびジョイントは、上記器具が上記器具ホルダーに取り付けられ、そして上記シャフトが少なくとも１つの自由度で移動するとき、平行四辺形を、上記器具の細長いシャフトを回転の中心に対して束縛するように規定する。上記第１の軸および上記平行四辺形連結ベースに隣接する上記平行四辺形の第１の辺が、上記回転の中心で上記シャフトと交差する。重要なことに、上記平行四辺形の第１の辺は、上記第１の軸から角度をなしてオフセットされる。 In a first aspect of the invention, a remote center manipulator for constraining the position of a surgical instrument is provided. A surgical instrument that can be coupled to an instrument holder during minimally invasive robotic surgery includes an elongate shaft. The shaft has a distal working end that is configured for insertion through the incision in the patient's body wall and into the body cavity. The remote center manipulator includes an articulation assembly having a mounting base rotatably coupled to a parallelogram coupling base for rotation about a first axis. The parallelogram connection base is connected to the instrument holder by a plurality of links and joints. The links and joints constrain the parallelogram to the elongated shaft of the instrument relative to the center of rotation when the instrument is attached to the instrument holder and the shaft moves in at least one degree of freedom. Stipulate. The first side of the parallelogram adjacent to the first axis and the parallelogram connecting base intersects the shaft at the center of rotation. Significantly, the first side of the parallelogram is offset at an angle from the first axis.
上記平行四辺形の第１の辺は、上記第１の軸から、少なくとも２゜だけ角度がオフセットされる。一般に、上記平行四辺形の第１の辺は、上記第１の軸から、約２゜〜約４５゜の範囲、好ましくは、約２゜〜約３５゜の範囲で角度がオフセットされる。上記平行四辺形の第１の辺は、しばしば、上記第１の軸の下で、一般に、上記平行四辺形の少なくとも１つの辺は上記第１の軸の下で延びる。上記マニピュレーターは、上記第１の軸に沿って±９０゜より大きい、好ましくは、上記第１の軸に沿って±９５゜より大きい範囲にある改良されたシャフト移動を提供する。特に、片持ちされた平行四辺形連結ベースは、上記第１の軸に沿って±１６８゜からの範囲でシャフト移動を提供、ここで、この第１の軸は、しばしば、偏揺れ軸と称される。有利には、上記オフセット関節連結アセンブリは、第２の軸に沿って±５５゜より大きい、好ましくは、この第２の軸に沿って±６０゜より大きいシャフト移動の改良された範囲を提供する。一般に、上記オフセット関節連結アセンブリは、上記第２の軸に沿って±７５゜の間の範囲にある改良されたシャフト移動を提供し、ここで、この第２の軸は、しばしば、ピッチ軸と称される。 The first side of the parallelogram is offset from the first axis by an angle of at least 2 °. In general, the first side of the parallelogram is offset in angle from the first axis in the range of about 2 ° to about 45 °, preferably in the range of about 2 ° to about 35 °. The first side of the parallelogram often extends below the first axis, and generally at least one side of the parallelogram extends below the first axis. The manipulator provides improved shaft movement that is greater than ± 90 ° along the first axis, preferably in the range greater than ± 95 ° along the first axis. In particular, the cantilevered parallelogram coupling base provides shaft movement in the range from ± 168 ° along the first axis, where the first axis is often referred to as the yaw axis. Is done. Advantageously, the offset articulation assembly provides an improved range of shaft movement greater than ± 55 ° along the second axis, preferably greater than ± 60 ° along the second axis. . Generally, the offset articulation assembly provides improved shaft movement in the range between ± 75 ° along the second axis, where the second axis is often the pitch axis. Called.
好ましくは、上記リンクの少なくとも１つは、屈曲リンク上で静止するために別のリンクのための間隔を提供するように屈曲している。この間隔は、ピッチ移動の改良された範囲をさらに可能にするように連結間の衝突を防ぐ。例えば、上記リンクは、約２２゜の角度で屈曲し得る。上記マニピュレーターは、少なくとも１つの自由度で釣り合っていなくても良い。従って、ブレーキシステムが上記関節連結アセンブリに連結され得る。このブレーキシステムは、上記ジョイントの少なくとも１つの関節を離脱可能に阻害する。好ましくは、上記複数のリンクおよびジョイントは、少なくとも１つのプーリー、およびこのプーリーに連結され、上記回転の中心に対してシャフト移動を束縛する形態である少なくとも１つの可撓性要素を備える。１つの実施形態では、これら複数のリンクおよびジョイントは、６つのプーリーおよび４つのベルトを備える。これら複数のリンクおよびジョイントは、サーボ機構によって駆動される。上記複数のリンクおよび上記平行四辺形連結ベースは、連結間衝突の可能性を減少するように、異なる平面でオフセットされている。上記リンクおよび上記器具ホルダーは、しかし、同一平面中に位置され得る。 Preferably, at least one of the links is bent to provide a spacing for another link to rest on the bent link. This spacing prevents collisions between connections so as to further allow an improved range of pitch movement. For example, the link can be bent at an angle of about 22 °. The manipulator may not be balanced with at least one degree of freedom. Accordingly, a brake system can be coupled to the articulation assembly. The brake system removably inhibits at least one joint of the joint. Preferably, the plurality of links and joints comprise at least one pulley and at least one flexible element coupled to the pulley and configured to constrain shaft movement relative to the center of rotation. In one embodiment, the plurality of links and joints comprise six pulleys and four belts. The plurality of links and joints are driven by a servo mechanism. The plurality of links and the parallelogram connection base are offset in different planes so as to reduce the possibility of collision between connections. The link and the instrument holder can, however, be located in the same plane.
一般に、上記関節連結アセンブリは、上記回転の中心に対するシャフト移動を束縛するような形態である。従って、上記シャフトは、このシャフトが少なくとも１つの自由度で旋回移動されるとき、上記回転の中心を通って実質的に整列されて維持される。好ましくは、この回転の中心は、例えば、腹腔鏡手術の間に腹腔壁でトロカールまたはカニューレとともに、内部手術部位への切開点と整列される。従って、上記外科用器具の端部エフェクターは、腹腔壁に対して危険な力を課すことなくオフセット遠隔中心ロボット利用マニピュレーターを用いてシャフトの近位端を移動することによって安全に位置決めされ得る。 In general, the articulation assembly is configured to constrain shaft movement relative to the center of rotation. Thus, the shaft is maintained substantially aligned through the center of rotation when the shaft is pivoted with at least one degree of freedom. Preferably, this center of rotation is aligned with the incision point to the internal surgical site, for example with a trocar or cannula in the abdominal wall during laparoscopic surgery. Thus, the end effector of the surgical instrument can be safely positioned by moving the proximal end of the shaft using an offset remote center robotic manipulator without imposing a dangerous force on the abdominal wall.
本発明の別の局面では、外科用器具の位置を束縛する遠隔中心マニピュレーターが提供される。最小侵襲的ロボット利用手術の間に器具ホルダーに連結可能な外科用器具は、細長いシャフトを含む。このシャフトは、患者の身体壁中の切開を通り、身体腔中への挿入のための形態である遠位作業端部を有する。上記遠隔中心マニピュレーターは、第１の軸の周りの回転のための平行四辺形連結ベースに回転可能に連結された取り付けベースを有する関節連結アセンブリを備える。この平行四辺形連結ベースは、複数のリンクおよび旋回軸によって上記器具ホルダーに連結される。このリンクおよび旋回軸は、上記器具が上記器具ホルダーに取り付けられ、そして上記シャフトが上記平行四辺形の平面に沿って移動するとき、平行四辺形を、上記器具の細長いシャフトを回転の中心に対して束縛するように規定する。重要なことに、上記第１の軸および上記平行四辺形連結ベースに隣接する上記平行四辺形の第１の旋回軸は、角度をなしてオフセットされ、そしてこれらリンクの少なくとも１つが屈曲される。 In another aspect of the invention, a remote center manipulator is provided that constrains the position of a surgical instrument. A surgical instrument that can be coupled to an instrument holder during minimally invasive robotic surgery includes an elongate shaft. The shaft has a distal working end that is configured for insertion through the incision in the patient's body wall and into the body cavity. The remote center manipulator includes an articulation assembly having a mounting base rotatably coupled to a parallelogram coupling base for rotation about a first axis. The parallelogram connection base is connected to the instrument holder by a plurality of links and a pivot shaft. The link and pivot axis allow the parallelogram to move about the elongated shaft of the instrument relative to the center of rotation when the instrument is attached to the instrument holder and the shaft moves along the plane of the parallelogram. To be bound. Importantly, the first pivot axis of the parallelogram adjacent to the first axis and the parallelogram coupling base is offset at an angle and at least one of these links is bent.
上記平行四辺形の第１の旋回軸は、上記第１の軸から、少なくとも２゜だけ、好ましくは、１０゜だけ角度がオフセットされる。一般に、上記平行四辺形の第１の旋回軸は、上記第１の軸から、約２゜〜約４５゜の範囲で、好ましくは、約２゜〜約３５゜の範囲で角度がオフセットされる。上記平行四辺形の第１の旋回軸は、しばしば、上記第１の軸の下で延び得、一般に、上記平行四辺形の少なくとも１つの旋回軸が上記第１の軸の下で延び得る。上記マニピュレーターは、上記第１の軸に沿って±９０゜より大きい範囲で、好ましくは上記第１の軸に沿って±９５゜より大きい範囲でシャフト移動を提供する。特に、片持ちされた平行四辺形連結ベースは、上記第１の軸、例えば、偏揺れ軸に沿って±１６８゜からの範囲で改良されたシャフト移動を提供する。有利には、上記オフセットされた平行四辺形および屈曲リンクは、一緒に、第２の軸に沿って±５５゜より大きい、好ましくは、この第２の軸に沿って±６０゜より大きいシャフト移動の範囲を提供する。代表的には、上記オフセットされた平行四辺形および屈曲リンクは、上記第２の軸、例えば、ピッチ軸に沿って±７５゜からの範囲で改良されたシャフト移動を提供する。 The parallelogram first pivot axis is offset in angle from the first axis by at least 2 °, preferably by 10 °. In general, the parallelogram first pivot axis is offset in angle from the first axis in the range of about 2 ° to about 45 °, and preferably in the range of about 2 ° to about 35 °. . The parallelogram first pivot axis can often extend below the first axis, and generally at least one pivot axis of the parallelogram can extend below the first axis. The manipulator provides shaft movement in a range greater than ± 90 ° along the first axis, preferably in a range greater than ± 95 ° along the first axis. In particular, the cantilevered parallelogram connection base provides improved shaft movement in the range from ± 168 ° along the first axis, eg, the yaw axis. Advantageously, the offset parallelogram and the flex link together have a shaft movement of more than ± 55 ° along the second axis, preferably more than ± 60 ° along the second axis. Provides a range of. Typically, the offset parallelograms and flex links provide improved shaft movement in the range from ± 75 ° along the second axis, eg, the pitch axis.
少なくとも１つのリンクは、屈曲リンク上で静止するために別のリンクのための間隔を提供するように所定角度（例えば、２２゜）で屈曲している。上記リンクおよび旋回軸の少なくとも１つは、少なくとも１つの自由度で釣り合っていない。従って、ブレーキシステムが上記関節連結アセンブリに連結され得、このブレーキシステムは、上記旋回軸の少なくとも１つの関節を離脱可能に阻害する。好ましくは、上記複数のリンクおよび旋回軸は、少なくとも１つのプーリー、およびこのプーリーに連結され、上記回転の中心に対してシャフト移動を束縛する形態である少なくとも１つの可撓性要素を備える。１つの実施形態では、これら複数のリンクおよび旋回軸は、６つのプーリーおよび４つのベルトを備える。これら複数のリンクおよび上記平行四辺形連結ベースは、異なる平面でオフセットされ、その一方、上記リンクおよび上記器具ホルダーは、しかし、同一平面中に位置され得る。 At least one link is bent at a predetermined angle (eg, 22 °) to provide a spacing for another link to rest on the bent link. At least one of the link and the pivot axis is not balanced with at least one degree of freedom. Accordingly, a brake system may be coupled to the articulation assembly, the brake system removably inhibiting at least one joint of the pivot axis. Preferably, the plurality of links and pivots comprise at least one pulley and at least one flexible element coupled to the pulley and configured to constrain shaft movement relative to the center of rotation. In one embodiment, the plurality of links and pivots comprise six pulleys and four belts. The plurality of links and the parallelogram connection base are offset in different planes, while the links and the instrument holder can be located in the same plane, however.
本発明のなお別の局面では、外科用器具の位置を束縛するための遠隔中心マニピュレーターが提供される。最小侵襲的ロボット利用手術の間に器具ホルダーに連結可能な外科用器具は、細長いシャフトを含む。このシャフトは、患者の身体壁中の切開を通り、身体腔中への挿入のための形態である遠位作業端部を有する。この遠隔中心マニピュレーターは、第１の軸の周りの回転のための平行四辺形連結ベースに回転可能に連結された取り付けベースを有する関節連結アセンブリを備える。この平行四辺形連結ベースは、複数のリンクおよび旋回軸によって上記器具ホルダーに連結される。これらリンクおよび旋回軸は、上記器具が上記器具ホルダーに取り付けられ、そして上記シャフトが該平行四辺形の平面に沿って移動するとき、平行四辺形を、上記器具の細長いシャフトを回転の中心に対して束縛するように規定する。上記第１の軸および上記平行四辺形は、上記回転の中心で上記シャフトと交差する。重要なことに、上記平行四辺形は、該第１の軸から角度をなしてオフセットされる。例えば、上記器具ホルダーに隣接するジョイントから上記回転の中心に延びる平行四辺形の遠位端は、上記細長いシャフトから角度をなしてオフセットされる。 In yet another aspect of the invention, a remote center manipulator for constraining the position of a surgical instrument is provided. A surgical instrument that can be coupled to an instrument holder during minimally invasive robotic surgery includes an elongate shaft. The shaft has a distal working end that is configured for insertion through the incision in the patient's body wall and into the body cavity. The remote center manipulator includes an articulation assembly having an attachment base that is rotatably connected to a parallelogram connection base for rotation about a first axis. The parallelogram connection base is connected to the instrument holder by a plurality of links and a pivot shaft. The links and pivots are such that when the instrument is attached to the instrument holder and the shaft moves along the plane of the parallelogram, the parallelogram is aligned with the elongated shaft of the instrument relative to the center of rotation. To be bound. The first axis and the parallelogram intersect the shaft at the center of rotation. Importantly, the parallelogram is offset at an angle from the first axis. For example, a parallelogram distal end extending from a joint adjacent to the instrument holder to the center of rotation is offset from the elongated shaft at an angle.
本発明のなお別の実施形態では、外科用器具の旋回運動のための遠隔中心マニピュレーターが提供される。最小侵襲的ロボット利用手術の間に器具ホルダーに連結可能な外科用器具は、細長いシャフトを含む。このシャフトは、近位端、および患者の身体壁中の切開を通り、身体腔中への挿入のための形態である遠位作業端部を有する。この遠隔中心マニピュレーターは、連結ベース、第１の連結アセンブリ、および第２の連結アセンブリを備える。この第１の連結アセンブリは、上記連結ベースによって旋回可能に支持され、そして第１の外側ハウジンクを有する。上記第２の連結アセンブリは、近位旋回ジョイントと遠位旋回ジョイントとの間で片持ちされ、そしてそれらの間に延びる第２の連結アセンブリ軸を規定する。上記近位旋回ジョイントは、上記第２の連結アセンブリを上記第１の連結アセンブリに連結する。上記遠位旋回ジョイントは、上記第２の連結アセンブリを上記器具ホルダーに連結する。上記第１および第２の旋回アセンブリは、上記シャフトの側方移動を上記シャフトに沿って配置された回転の中心の周りの旋回移動に束縛する。上記第２の連結は、第２の外側ハウジングを有し、この第２の外側ハウジングは、上記第１のジョイントと第２のジョイントとの間の間に配置され、そしてそれらから分離された凹部を有し、上記第１の連結アセンブリの第１の外側ハウジングが、上記シャフトの近位端が上記連結ベースに向かって移動するとき、上記凹部中に突き出し得、そして上記第２の連結軸を横切り得る。上記第２の連結アセンブリは、上記近位旋回ジョイントと上記遠位旋回ジョイントとの間で伸張する可撓性部材を備え得、そして少なくとも１つのガイドが、上記可撓性部材を、この可撓性部材を上記凹部から離れて配置するように側方に係合する。 In yet another embodiment of the present invention, a remote center manipulator for pivoting movement of a surgical instrument is provided. A surgical instrument that can be coupled to an instrument holder during minimally invasive robotic surgery includes an elongate shaft. The shaft has a proximal end and a distal working end that is configured for insertion through the incision in the patient's body wall and into the body cavity. The remote center manipulator includes a connection base, a first connection assembly, and a second connection assembly. The first coupling assembly is pivotally supported by the coupling base and has a first outer housing. The second coupling assembly is cantilevered between the proximal pivot joint and the distal pivot joint and defines a second coupling assembly axis extending therebetween. The proximal pivot joint connects the second connection assembly to the first connection assembly. The distal pivot joint couples the second coupling assembly to the instrument holder. The first and second pivot assemblies constrain lateral movement of the shaft to pivot movement about the center of rotation disposed along the shaft. The second connection has a second outer housing, the second outer housing being disposed between and separated from the first joint and the second joint. And the first outer housing of the first coupling assembly can protrude into the recess when the proximal end of the shaft moves toward the coupling base, and the second coupling shaft You can cross. The second coupling assembly may comprise a flexible member that extends between the proximal pivot joint and the distal pivot joint, and at least one guide connects the flexible member to the flexible pivot assembly. The engaging member is engaged laterally so as to be disposed away from the recess.
本発明のなお別の局面では、外科用器具を採用して、患者の身体腔内で最小侵襲的ロボット利用手術を実施するための方法が提供される。最小侵襲的ロボット利用手術の間に器具ホルダーの連結可能な外科用器具は、細長いシャフトを含む。このシャフトは、患者の身体壁中の切開を通る身体腔中への挿入のための形態である遠位作業端部を有する。子の方法は、上記のようなオフセットされた関節連結アセンブリを提供する工程を包含する。この器具のシャフトの少なくとも１つの遠位作業端部が上記切開を通り身体腔中に導入される。上記器具の少なくともシャフトは、上記遠位作業端部が身体腔内にある間に、少なくとも１つの自由度で旋回可能に移動される。上記オフセットされる関節連結アセンブリは、上記シャフトの側方移動を上記回転の中心の周りの旋回移動に束縛し、このシャフトは、この回転の中心を通って実施的に整列されて維持される。 In yet another aspect of the invention, a method is provided for employing a surgical instrument to perform minimally invasive robotic surgery within a patient's body cavity. A surgical instrument that is connectable to an instrument holder during minimally invasive robotic surgery includes an elongate shaft. The shaft has a distal working end that is configured for insertion into a body cavity through an incision in a patient's body wall. The child method includes providing an offset articulation assembly as described above. At least one distal working end of the instrument shaft is introduced through the incision and into the body cavity. At least the shaft of the instrument is pivotably moved with at least one degree of freedom while the distal working end is in the body cavity. The offset articulation assembly constrains the lateral movement of the shaft to a pivoting movement about the center of rotation, and the shaft is maintained in effective alignment through the center of rotation.
本発明の性質および利点のさらなる理解は、本明細書および図面の残りの部分への参照によって明らかになる。
例えば、本願発明は以下を提供する。
（項目１）
最小侵襲的ロボット利用手術の間に器具ホルダーに連結された外科用器具の位置を束縛するための遠隔中心マニピュレーターであって、上記外科用器具が、細長いシャフトを含み、上記シャフトが、患者の身体壁中の切開を通り、身体腔中への挿入のための形態である遠位作業端部を有し、上記遠隔中心マニピュレーターが：
第１の軸の周りの回転のための平行四辺形連結ベースに回転可能に連結された取り付けベースを有する関節連結アセンブリを備え、上記平行四辺形連結ベースが複数のリンクおよびジョイントによって上記器具ホルダーに連結され、上記リンクおよびジョイントが、上記器具が上記器具ホルダーに取り付けられ、そして上記シャフトが少なくとも１つの自由度で移動するとき、平行四辺形を、上記器具の細長いシャフトを回転の中心に対して束縛するように規定し、ここで、上記第１の軸および上記平行四辺形連結ベースに隣接する上記平行四辺形の第１の辺が、上記回転の中心で上記シャフトと交差し、そして上記平行四辺形の第１の辺が上記第１の軸から角度をなしてオフセットされる、マニピュレーター。
（項目２）
上記第１の軸が、上記回転の中心で交差する、項目１に記載のマニピュレーター。
（項目３）
上記平行四辺形の第１の辺が、上記第１の軸から、少なくとも２゜だけ角度がオフセットされる、項目２に記載のマニピュレーター。
（項目４）
上記平行四辺形の第１の辺が、上記第１の軸から、約２゜〜約４５゜の範囲で角度がオフセットされる、項目２に記載のマニピュレーター。
（項目５）
上記平行四辺形の第１の辺が、上記第１の軸から、約１０゜だけ角度がオフセットされる、項目２に記載のマニピュレーター。
（項目６）
上記平行四辺形の遠位端が、上記器具ホルダーに隣接するジョイントから上記回転の中心まで延び、そして上記平行四辺形の遠位端が、上記細長いシャフトから角度がオフセットされる、項目２に記載のマニピュレーター。
（項目７）
上記平行四辺形の第１の辺が、上記第１の軸の下で延びる、項目２に記載のマニピュレーター。
（項目８）
上記マニピュレーターが、上記第１の軸に対して±９０゜より大きい範囲にあるシャフト移動を提供する、項目２に記載のマニピュレーター。
（項目９）
上記マニピュレーターが、上記第１の軸に対して±１６８゜の間の範囲にあるシャフト移動を提供する、項目２に記載のマニピュレーター。
（項目１０）
上記マニピュレーターが、上記第１の軸に対して±５５゜より大きい範囲にあるシャフト移動を提供する、項目２に記載のマニピュレーター。
（項目１１）
上記マニピュレーターが、上記第１の軸に対して±７５゜の間の範囲にあるシャフト移動を提供する、項目２に記載のマニピュレーター。
（項目１２）
上記リンクの少なくとも１つが屈曲している、項目２に記載のマニピュレーター。
（項目１３）
上記リンクの少なくとも１つが約２２゜の角度で屈曲している、項目１２に記載のマニピュレーター。
（項目１４）
上記マニピュレーターが、少なくとも１つの自由度で釣り合っていない，項目２に記載のマニピュレーター。
（項目１５）
上記関節連結アセンブリに連結されたブレーキシステムをさらに備え、上記ブレーキシステムが、上記ジョイントの少なくとも１つの関節を離脱可能に阻害する、項目２に記載のマニピュレーター。
（項目１６）
上記複数のリンクおよびジョイントが、少なくとも１つのプーリー、および上記プーリーに連結され、上記回転の中心に対してシャフト移動を束縛する形態である少なくとも１つの可撓性要素を備える、項目２に記載のマニピュレーター。
（項目１７）
上記複数のリンクおよびジョイントが、６つのプーリーおよび４つのベルトを備える、項目２に記載のマニピュレーター。
（項目１８）
上記複数のリンクおよびジョイントが、サーボ機構によって駆動される、項目２に記載のマニピュレーター。
（項目１９）
上記複数のリンクおよび上記平行四辺形が、異なる平面でオフセットされている、項目２に記載のマニピュレーター。
（項目２０）
上記リンクおよび上記器具ホルダーが、同一平面中に位置される、項目２に記載のマニピュレーター。
（項目２１）
上記関節連結アセンブリが、上記回転の中心に対するシャフト移動を、上記シャフトが少なくとも１つの自由度で回転移動されるとき、上記シャフトが上記回転の中心を通って実質的に整列されるように束縛するような形態である、項目２に記載のマニピュレーター。（項目２２）
最小侵襲的ロボット利用手術の間に器具ホルダーに連結された外科用器具の位置を束縛するための遠隔中心マニピュレーターであって、上記外科用器具が、細長いシャフトを含み、上記シャフトが、患者の身体壁中の切開を通り、身体腔中への挿入のための形態である遠位作業端部を有し、上記遠隔中心マニピュレーターが：
第１の軸の周りの回転のための平行四辺形連結ベースに回転可能に連結された取り付けベースを有する関節連結アセンブリを備え、上記平行四辺形連結ベースが複数のリンクおよび旋回軸によって上記器具ホルダーに連結され、上記リンクおよび旋回軸が、上記器具が上記器具ホルダーに取り付けられ、そして上記シャフトが上記平行四辺形の平面に沿って移動するとき、平行四辺形を、上記器具の細長いシャフトを回転の中心に対して束縛するように規定し、ここで、上記第１の軸および上記平行四辺形連結ベースに隣接する上記平行四辺形の第１の旋回軸が、角度をなしてオフセットされる、マニピュレーター。
（項目２３）
上記第１の軸および第２の軸が、上記回転の中心で交差する、項目２２に記載のマニピュレーター。
（項目２４）
上記平行四辺形の第１の旋回軸が、上記第１の軸から、少なくとも２゜だけ角度がオフセットされる、項目２３に記載のマニピュレーター。
（項目２５）
上記平行四辺形の第１の旋回軸が、上記第１の軸から、約２゜〜約４５゜の範囲で角度がオフセットされる、項目２３に記載のマニピュレーター。
（項目２６）
上記平行四辺形の第１の旋回軸が、上記第１の軸から、約１０゜だけ角度がオフセットされる、項目２３に記載のマニピュレーター。
（項目２７）
上記平行四辺形の遠位端が、上記器具ホルダーに隣接するジョイントから上記回転の中心まで延び、そして上記平行四辺形の遠位端が、上記細長いシャフトから角度がオフセットされる、項目２３に記載のマニピュレーター。
（項目２８）
上記平行四辺形の第１の旋回軸が、上記第１の軸の下で延びる、項目２３に記載のマニピュレーター。
（項目２９）
上記マニピュレーターが、上記第１の軸に対して±９０゜より大きい範囲にあるシャフト移動を提供する、項目２３に記載のマニピュレーター。
（項目３０）
上記マニピュレーターが、上記第１の軸に対して±１６８゜の間の範囲にあるシャフト移動を提供する、項目２３に記載のマニピュレーター。
（項目３１）
上記オフセットされた平行四辺形および屈曲リンクが、上記第２の軸に対して±５５゜より大きい範囲にあるシャフト移動を提供する、項目２３に記載のマニピュレーター。
（項目３２）
上記オフセットされた平行四辺形および屈曲リンクが、上記第２の軸に対して±７５゜より大きい範囲にあるシャフト移動を提供する、項目２３に記載のマニピュレーター。
（項目３３）
上記リンクの少なくとも１つが約２２゜の角度で屈曲している、項目２３に記載のマニピュレーター。
（項目３４）
上記マニピュレーターが、少なくとも１つの自由度で釣り合っていない，項目２３に記載のマニピュレーター。
（項目３５）
上記関節連結アセンブリに連結されたブレーキシステムをさらに備え、上記ブレーキシステムが、上記旋回軸の少なくとも１つの関節を離脱可能に阻害する、項目３４に記載のマニピュレーター。
（項目３６）
上記複数のリンクおよび旋回軸が、少なくともプーリー、および上記プーリーに連結され、上記回転の中心に対してシャフト移動を束縛する形態である少なくとも１つの可撓性要素を備える、項目２３に記載のマニピュレーター。
（項目３７）
上記複数のリンクおよび旋回軸が、６つのプーリーおよび４つのベルトを備える、項目２３に記載のマニピュレーター。
（項目３８）
上記複数のリンクおよび上記平行四辺形が、異なる平面でオフセットされている、項目２３に記載のマニピュレーター。
（項目３９）
上記リンクおよび上記器具ホルダーが、同一平面中に位置される、項目２３に記載のマニピュレーター。
（項目４０）
最小侵襲的ロボット利用手術の間に器具ホルダーに連結された外科用器具の位置を束縛するための遠隔中心マニピュレーターであって、上記外科用器具が、細長いシャフトを含み、上記シャフトが、患者の身体壁中の切開を通り、身体腔中への挿入のための形態である遠位作業端部を有し、上記遠隔中心マニピュレーターが：
第１の軸の周りの回転のための平行四辺形連結ベースに回転可能に連結された取り付けベースを有する関節連結アセンブリを備え、上記平行四辺形連結ベースが複数のリンクおよび旋回軸によって上記器具ホルダーに連結され、上記リンクおよび旋回軸が、上記器具が上記器具ホルダーに取り付けられ、そして上記シャフトが上記平行四辺形の平面に沿って移動するとき、平行四辺形を、上記器具の細長いシャフトを回転の中心に対して束縛するように規定し、ここで、上記第１の軸および上記平行四辺形が上記回転の中心で上記シャフトと交差し、そして上記平行四辺形が上記第１の軸から角度をなしてオフセットされる、マニピュレーター。
（項目４１）
上記第１の軸および第２の軸が、上記回転の中心で交差する、項目４０に記載のマニピュレーター。
（項目４２）
上記平行四辺形が、上記第１の軸から、少なくとも２゜だけ角度がオフセットされる、項目４１に記載のマニピュレーター。
（項目４３）
上記平行四辺形が、上記第１の軸から、約２゜〜約４５゜の範囲で角度がオフセットされる、項目４１に記載のマニピュレーター。
（項目４４）
上記平行四辺形が、上記第１の軸から、約１０゜だけ角度がオフセットされる、項目４１に記載のマニピュレーター。
（項目４５）
上記平行四辺形連結ベースに隣接する上記平行四辺形の第１の軸および第１の辺が、上記回転の中心で上記シャフトと交差し、そして上記平行四辺形の第１の辺がが、上記第１の軸から角度がオフセットされる、項目４１に記載のマニピュレーター。
（項目４６）
上記平行四辺形連結ベースに隣接する上記第１の軸および上記平行四辺形の第１の旋回軸が、上記回転の中心で上記シャフトと交差し、そして上記平行四辺形の第１の旋回軸が上記第１の軸から角度がオフセットされる、
上記第１の軸の下で延びる、項目４１に記載のマニピュレーター。
（項目４７）
上記平行四辺形の遠位端が、上記器具ホルダーに隣接するジョイントから上記回転の中心まで延び、そして上記平行四辺形の遠位端が、上記細長いシャフトから角度をなしてオフセットされる、項目４１に記載のマニピュレーター。
（項目４８）
最小侵襲的ロボット利用手術の間に器具ホルダーに連結された外科用器具の旋回移動のための遠隔中心マニピュレーターであって、上記外科用器具が、細長いシャフトを含み、上記シャフトが、近位端、および患者の身体壁中の切開を通り、身体腔中への挿入のための形態である遠位作業端部を有し、上記遠隔中心マニピュレーターが：
連結ベース；
上記連結ベースによって旋回可能に支持される第１の連結アセンブリであって、第１の外側ハウジンクを有する連結アセンブリ；および
近位旋回ジョイントと遠位旋回ジョイントとの間で片持ちされ、そしてそれらの間に延びる第２の連結アセンブリ軸を規定する第２の連結アセンブリを備え、上記近位旋回ジョイントが上記第２の連結アセンブリを上記第１の連結アセンブリに連結し、上記遠位旋回ジョイントが上記第２の連結アセンブリを上記器具ホルダーに連結し、上記第１および第２の旋回アセンブリが上記シャフトの側方移動を上記シャフトに沿って配置された回転の中心の周りの旋回移動に束縛し、上記第２の連結が第２の外側ハウジングを有し、上記第２の外側ハウジングが上記第１のジョイントと第２のジョイントとの間の間に配置され、そしてそれらから分離された凹部を有し、上記第１の連結アセンブリの第１の外側ハウジングが、上記シャフトの近位端が上記連結ベースに向かって移動するとき、上記凹部中に突き出し、そして上記第２の連結軸を横切り得る、マニピュレーター。
（項目４９）
上記第２の連結アセンブリが、上記近位旋回ジョイントと上記遠位旋回ジョイントとの間で伸張する可撓性部材を備え、そして少なくとも１つのガイドが、上記可撓性部材を、上記可撓性部材を上記凹部から離れて配置するように側方に係合する、項目４８に記載のマニピュレーター。
（項目５０）
器具ホルダーに連結された外科用器具を採用して、患者の身体腔内で最小侵襲的ロボット利用手術を実施するための方法であって、上記器具が、細長いシャフトを含み、上記シャフトが身体壁中の切開を通る身体腔中への挿入のための形態である遠位作業端部を有し：
第１の軸の周りの回転のための平行四辺形連結ベースに回転可能に連結された取り付けベースを有する関節連結アセンブリを提供する工程であって、上記平行四辺形連結ベースが、複数のリンクおよびジョントによって上記器具ホルダーに連結され、上記リンクおよびジョイントが、平行四辺形を、上記器具の細長いシャフトが、上記器具が上記器具ホルダーに取り付けられ、そして上記シャフトが少なくとも１つの自由度で移動するとき、上記器具の細長いシャフトを回転の中心に対して束縛するように規定し、ここで、上記第１の軸および上記平行四辺形連結ベースに隣接する平行四辺形の第１の辺が、上記回転の中心で上記シャフトと交差し、そして上記平行四辺形の第１の辺が上記第１の軸から角度をなしてオフセットされる工程；
上記器具を上記器具ホルダーに連結する工程；
上記器具シャフトの少なくとも遠位作業端部を、上記身体腔中に上記切開を通じて導入する工程；および
上記器具の少なくとも１つのシャフトを、少なくとも１つの自由度で、上記遠位作業端部が上記身体腔内にある間、そして上記オフセットされた関節連結アセンブリが、上記シャフトの側方移動を上記回転の中心の周りの旋回移動に、上記シャフトが上記回転の中心を通って実質的に整列されるように束縛する間、旋回可能に移動する工程、を包含する、方法。A further understanding of the nature and advantages of the present invention will become apparent by reference to the remaining portions of the specification and drawings.
For example, the present inventionthat provides the following.
(Item 1)
A remote central manipulator for constraining the position of a surgical instrument coupled to an instrument holder during minimally invasive robotic surgery, wherein the surgical instrument includes an elongated shaft, the shaft comprising a patient's body Having a distal working end that is configured for insertion into a body cavity through an incision in the wall, the remote central manipulator includes:
An articulation assembly having a mounting base rotatably connected to a parallelogram connection base for rotation about a first axis, the parallelogram connection base being connected to the instrument holder by a plurality of links and joints Coupled, the link and the joint, when the instrument is attached to the instrument holder and the shaft moves in at least one degree of freedom, the parallelogram is aligned with the elongated shaft of the instrument relative to the center of rotation. A first side of the parallelogram adjacent to the first axis and the parallelogram coupling base intersects the shaft at the center of rotation and the parallel A manipulator wherein the first side of the quadrilateral is offset at an angle from the first axis.
(Item 2)
The manipulator according to item 1, wherein the first axis intersects at the center of rotation.
(Item 3)
Item 3. The manipulator of item 2, wherein the first side of the parallelogram is offset from the first axis by an angle of at least 2 °.
(Item 4)
The manipulator according to item 2, wherein the first side of the parallelogram is offset in angle from the first axis in the range of about 2 ° to about 45 °.
(Item 5)
Item 3. The manipulator of item 2, wherein the first side of the parallelogram is offset from the first axis by an angle of about 10 °.
(Item 6)
Item 3. The distal end of the parallelogram extends from a joint adjacent to the instrument holder to the center of rotation and the distal end of the parallelogram is offset in angle from the elongated shaft. Manipulator.
(Item 7)
Item 3. The manipulator according to item 2, wherein the first side of the parallelogram extends under the first axis.
(Item 8)
Item 3. The manipulator of item 2, wherein the manipulator provides shaft movement in a range greater than ± 90 ° relative to the first axis.
(Item 9)
Item 3. The manipulator of item 2, wherein the manipulator provides shaft movement in a range between ± 168 ° relative to the first axis.
(Item 10)
Item 3. The manipulator of item 2, wherein the manipulator provides shaft movement in a range greater than ± 55 ° relative to the first axis.
(Item 11)
Item 3. The manipulator of item 2, wherein the manipulator provides shaft movement in a range between ± 75 degrees with respect to the first axis.
(Item 12)
The manipulator according to item 2, wherein at least one of the links is bent.
(Item 13)
13. A manipulator according to item 12, wherein at least one of the links is bent at an angle of about 22 °.
(Item 14)
Item 3. The manipulator according to item 2, wherein the manipulator is not balanced with at least one degree of freedom.
(Item 15)
The manipulator according to item 2, further comprising a brake system coupled to the joint coupling assembly, wherein the brake system removably inhibits at least one joint of the joint.
(Item 16)
Item 3. The item 2, wherein the plurality of links and joints comprise at least one pulley and at least one flexible element coupled to the pulley and configured to constrain shaft movement relative to the center of rotation. Manipulator.
(Item 17)
Item 3. The manipulator of item 2, wherein the plurality of links and joints comprise six pulleys and four belts.
(Item 18)
The manipulator according to item 2, wherein the plurality of links and joints are driven by a servomechanism.
(Item 19)
The manipulator according to item 2, wherein the plurality of links and the parallelogram are offset in different planes.
(Item 20)
Item 3. The manipulator according to item 2, wherein the link and the instrument holder are located in the same plane.
(Item 21)
The articulation assembly constrains shaft movement relative to the center of rotation such that the shaft is substantially aligned through the center of rotation when the shaft is rotationally moved with at least one degree of freedom. Item 3. The manipulator according to item 2, which is in such a form. (Item 22)
A remote central manipulator for constraining the position of a surgical instrument coupled to an instrument holder during minimally invasive robotic surgery, wherein the surgical instrument includes an elongated shaft, the shaft comprising a patient's body Having a distal working end that is configured for insertion into a body cavity through an incision in the wall, the remote central manipulator includes:
An articulation assembly having a mounting base that is rotatably connected to a parallelogram connection base for rotation about a first axis, the parallelogram connection base comprising a plurality of links and a pivot axis, the instrument holder The link and pivot axis rotate the parallelogram to the elongated shaft of the instrument when the instrument is attached to the instrument holder and the shaft moves along the plane of the parallelogram. Wherein the first pivot axis of the parallelogram adjacent to the first parallel axis and the parallelogram coupling base is offset at an angle; Manipulator.
(Item 23)
The manipulator according to item 22, wherein the first axis and the second axis intersect at the center of rotation.
(Item 24)
24. A manipulator according to item 23, wherein the parallelogram first pivot axis is offset in angle by at least 2 ° from the first axis.
(Item 25)
24. The manipulator of item 23, wherein the parallelogram first pivot axis is offset in angle from the first axis in a range of about 2 degrees to about 45 degrees.
(Item 26)
24. The manipulator of item 23, wherein the parallelogram first pivot axis is offset in angle by about 10 degrees from the first axis.
(Item 27)
The distal end of the parallelogram extends from a joint adjacent to the instrument holder to the center of rotation, and the distal end of the parallelogram is offset in angle from the elongate shaft. Manipulator.
(Item 28)
24. A manipulator according to item 23, wherein the parallelogram first pivot axis extends under the first axis.
(Item 29)
24. The manipulator of item 23, wherein the manipulator provides shaft movement in a range greater than ± 90 ° relative to the first axis.
(Item 30)
24. The manipulator of item 23, wherein the manipulator provides shaft movement in a range between ± 168 ° with respect to the first axis.
(Item 31)
24. The manipulator of item 23, wherein the offset parallelogram and flex links provide shaft movement in a range greater than ± 55 ° relative to the second axis.
(Item 32)
24. A manipulator according to item 23, wherein the offset parallelogram and flex links provide shaft movement in a range greater than ± 75 ° relative to the second axis.
(Item 33)
24. A manipulator according to item 23, wherein at least one of the links is bent at an angle of about 22 °.
(Item 34)
24. A manipulator according to item 23, wherein the manipulator is not balanced with at least one degree of freedom.
(Item 35)
35. The manipulator of item 34, further comprising a brake system coupled to the articulation assembly, wherein the brake system removably inhibits at least one joint of the pivot axis.
(Item 36)
24. The manipulator of item 23, wherein the plurality of links and pivots comprise at least a pulley and at least one flexible element coupled to the pulley and configured to constrain shaft movement relative to the center of rotation. .
(Item 37)
24. The manipulator according to item 23, wherein the plurality of links and pivots comprise six pulleys and four belts.
(Item 38)
24. A manipulator according to item 23, wherein the plurality of links and the parallelogram are offset in different planes.
(Item 39)
24. A manipulator according to item 23, wherein the link and the instrument holder are located in the same plane.
(Item 40)
A remote central manipulator for constraining the position of a surgical instrument coupled to an instrument holder during minimally invasive robotic surgery, wherein the surgical instrument includes an elongated shaft, the shaft comprising a patient's body Having a distal working end that is configured for insertion into a body cavity through an incision in the wall, the remote central manipulator includes:
An articulation assembly having a mounting base that is rotatably connected to a parallelogram connection base for rotation about a first axis, the parallelogram connection base comprising a plurality of links and a pivot axis, the instrument holder The link and pivot axis rotate the parallelogram to the elongated shaft of the instrument when the instrument is attached to the instrument holder and the shaft moves along the plane of the parallelogram. , Wherein the first axis and the parallelogram intersect the shaft at the center of rotation and the parallelogram is angled from the first axis. A manipulator that is offset in the form of
(Item 41)
41. The manipulator of item 40, wherein the first axis and the second axis intersect at the center of rotation.
(Item 42)
42. A manipulator according to item 41, wherein the parallelogram is offset in angle by at least 2 ° from the first axis.
(Item 43)
42. A manipulator according to item 41, wherein the parallelogram is offset in angle from the first axis in the range of about 2 ° to about 45 °.
(Item 44)
42. A manipulator according to item 41, wherein the parallelogram is offset in angle from the first axis by about 10 °.
(Item 45)
A first axis and a first side of the parallelogram adjacent to the parallelogram connecting base intersect the shaft at the center of rotation, and a first side of the parallelogram is the above 42. The manipulator according to item 41, wherein the angle is offset from the first axis.
(Item 46)
The first axis adjacent to the parallelogram connecting base and the first pivot axis of the parallelogram intersect the shaft at the center of rotation, and the first pivot axis of the parallelogram is The angle is offset from the first axis,
42. A manipulator according to item 41, which extends under the first axis.
(Item 47)
Item 41 wherein the parallelogram distal end extends from a joint adjacent to the instrument holder to the center of rotation and the parallelogram distal end is offset at an angle from the elongated shaft. The manipulator described in 1.
(Item 48)
A remote central manipulator for pivoting a surgical instrument coupled to an instrument holder during minimally invasive robotic surgery, wherein the surgical instrument includes an elongated shaft, the shaft comprising a proximal end, And having a distal working end that is configured for insertion into a body cavity through an incision in the patient's body wall, the remote central manipulator includes:
Consolidated base;
A first coupling assembly pivotally supported by the coupling base, the coupling assembly having a first outer housing; and cantilevered between the proximal pivot joint and the distal pivot joint; and A second coupling assembly defining a second coupling assembly axis extending therebetween, wherein the proximal pivot joint couples the second coupling assembly to the first coupling assembly, and the distal pivot joint includes the A second coupling assembly coupled to the instrument holder, wherein the first and second pivot assemblies constrain lateral movement of the shaft to pivotal movement about a center of rotation disposed along the shaft; The second connection has a second outer housing, and the second outer housing is between the first joint and the second joint. Having a recess disposed therebetween and separated therefrom, the first outer housing of the first coupling assembly is disposed in the recess when the proximal end of the shaft moves toward the coupling base. And a manipulator that can traverse the second connecting shaft.
(Item 49)
The second coupling assembly includes a flexible member that extends between the proximal pivot joint and the distal pivot joint, and at least one guide connects the flexible member to the flexible joint. 49. A manipulator according to item 48, wherein the member is engaged laterally to place the member away from the recess.
(Item 50)
A method for performing minimally invasive robotic surgery in a patient's body cavity employing a surgical instrument coupled to an instrument holder, the instrument comprising an elongate shaft, the shaft being a body wall Having a distal working end that is configured for insertion into a body cavity through an incision in:
Providing an articulation assembly having a mounting base rotatably coupled to a parallelogram coupling base for rotation about a first axis, the parallelogram coupling base comprising a plurality of links and Connected to the instrument holder by Jonto, when the link and joint are parallelograms, the elongated shaft of the instrument is attached to the instrument holder, and the shaft moves in at least one degree of freedom. Defining an elongated shaft of the instrument to be constrained to a center of rotation, wherein a first side of a parallelogram adjacent to the first axis and the parallelogram coupling base is the rotation Intersecting the shaft at the center of and the first side of the parallelogram is offset from the first axis at an angle;
Connecting the instrument to the instrument holder;
Introducing at least the distal working end of the instrument shaft into the body cavity through the incision; and at least one shaft of the instrument with at least one degree of freedom, wherein the distal working end is the body. While in the cavity and the offset articulation assembly causes the shaft to move substantially laterally through the center of rotation, with the shaft moving laterally into a pivotal movement about the center of rotation. Moving in a pivotable manner while constraining.
以下の図面は、詳細な説明を参照して読まれるべきである。異なる図面における同様の番号は、同様の要素に言及する。必ずしもスケール通りではない図面は、本発明の実施形態を例示して描写し、そして本発明の範囲を制限する意図はない。
（発明の詳細な説明）
図１〜４は、最小侵襲的ロボット利用手術を実施するためのロボット利用外科用システム１を示し、これは、米国特許第６，２４６，２００号中により詳細に記載されている。操作者Ｏ（一般に外科医）は、手術台Ｔに横たわる患者Ｐに対し最小侵襲性外科的手順を実施し、この操作者Ｏは、医師のコンソール３で１つ以上の入力デバイスまたはマスター２を操作する。外科医の入力に応答して、コンソール３のコンピュータープロセッサー４は、内視鏡器具またはツール５の移動を指示し、ロボット患者側システム６（この例では、荷車に載せられたシステム）を経由して器具のサーボ機構移動を行う。(Detailed description of the invention)
1-4 show a robotic surgical system 1 for performing minimally invasive robotic surgery, which is described in more detail in US Pat. No. 6,246,200. An operator O (generally a surgeon) performs a minimally invasive surgical procedure on a patient P lying on the operating table T, and the operator O operates one or more input devices or masters 2 at the doctor's console 3. To do. In response to the surgeon's input, the computer processor 4 of the console 3 directs the movement of the endoscopic instrument or tool 5 via the robot patient side system 6 (in this example, a system on a cart). Move the servo mechanism of the instrument.
代表的には、患者側システムまたは荷車６は、少なくとも３つのロボットマニピュレーターアームを含む。２つのアームまたは連結７（この例では、荷車６の側面に載せられる）は、サーボマニピュレーター８を支持および位置決めし、これは、外科用ツール５を駆動し；そして１つのアームまたは連結９（この例では、荷車６の中心に載せられる）は、サーボマニピュレーター１０を支持および位置決めし、これは、内部手術部位の画像（好ましくは立体鏡）を捕捉する内視鏡／カメラプローブ１１の移動を制御する。 Typically, the patient side system or cart 6 includes at least three robot manipulator arms. Two arms or links 7 (in this example mounted on the side of the cart 6) support and position the servo manipulator 8, which drives the surgical tool 5; and one arm or link 9 (this In the example, mounted in the center of the cart 6) supports and positions the servo manipulator 10, which controls the movement of the endoscope / camera probe 11 to capture an image (preferably a stereoscope) of the internal surgical site. To do.
内部手術部位の画像は、医師のコンソール３中の立体鏡ディスプレイビュワー１２によって外科医または操作者Ｏに示され、そしてアシスタントのディスプレイ１４によってアシスタントＡに同時に示される。アシスタントＡは、１つ以上の外科用マニピュレーター８（および／または１０）中のツール５を、代替のツールまたは器具５’に交換すること、関連する非ロボット医療器具および装置を作動することなどで、セットアップ連結アーム７、９を用い、患者Ｐに対してマニピュレーター８および１０を予備位置決めを支援する。 An image of the internal surgical site is shown to the surgeon or operator O by the stereoscopic display viewer 12 in the physician's console 3 and simultaneously to the assistant A by the assistant's display 14. Assistant A may replace the tool 5 in one or more surgical manipulators 8 (and / or 10) with an alternative tool or instrument 5 ', activate associated non-robot medical instruments and devices, etc. , Use the set-up connecting arms 7, 9 to assist in pre-positioning the manipulators 8 and 10 relative to the patient P
おおまかにいえば、アームまたは連結７、９は、代表的には、組織が操作される間固定された形態にある、患者側システム６の位置決め連結またはセットアップアーム部分を備え、そしてマニピュレーター８、１０は、外科医にコンソール３の指令の下で能動的に関節運動する駆動部分を備える。この能動的に駆動される部分を、本明細書では、一般に、「マニピュレーター」といい、そして患者側システム連結の位置決め連結の固定可能な部分を本明細書では「セットアップアーム」といい、このようなセットアップアームは、必要に応じ、動力を与えられ、そしてコンピューター制御されるジョイントを有し得ることが注記される。 Broadly speaking, the arms or connections 7, 9 comprise a positioning connection or set-up arm portion of the patient side system 6, typically in a fixed configuration while the tissue is manipulated, and the manipulators 8, 10 Comprises a drive part that is actively articulated under the command of the console 3 to the surgeon. This actively driven part is generally referred to herein as a “manipulator” and the fixable part of the positioning connection of the patient side system connection is referred to herein as a “setup arm”, such as It is noted that a simple setup arm can have a joint that is powered and computer controlled as required.
用語法の便宜のため、外科用ツールに影響する組織に作用する８のようなマニピュレーターは、本明細書では、一般に、ＰＳＭ（患者側マニピュレーター）と称される、そして内視鏡１１のような画像捕捉またはデータ獲得デバイスを制御する１０のようなマニピュレーターは、一般に、本明細書では、ＥＣＭ（内視鏡−カメラマニピュレーター）と称され、このような遠隔ロボットマニピュレーターは、必要に応じて、手術で有用な、広範な範囲の器具、ツールおよびデバイスを、操縦および制御することが注記される。 For convenience of terminology, a manipulator such as 8 that acts on tissue affecting the surgical tool is generally referred to herein as a PSM (patient side manipulator) and such as the endoscope 11 A manipulator such as 10 that controls an image capture or data acquisition device is generally referred to herein as an ECM (endoscope-camera manipulator), and such a remote robotic manipulator can be operated on as needed. It is noted that a wide range of instruments, tools and devices that are useful in and steer and control.
図２は、図１の荷車に載せられた遠隔手術患者側システム６の斜視図を示し、２つのＰＳＭ８および１つのＥＣＭ１０を含む。荷車システム６は、カラム１５を含み、これは、次に、３つの位置決め連結またはセットアップアームを載せ、各々がＰＳＭ８の１つを支持する２つのＰＳＭセットアップアーム７、およびＥＣＭ１０を支持する１つのセットアップアーム９を含む。ＰＳＭセットアップアーム７は各々が、６つの自由度をもち、そして中央に載せられたＥＣＭセットアップアーム９の各側面上に載せられるものである。ＥＣＭセットアップアーム９は、６つより少ない重度を有し、そしてＥＣＭ１０は、代表的にはＰＳＭ８に含まれるような、関節のある外科用器具のために提供されるツール作動駆動システムのすべてを含まなくても良い。各ＰＳＭ８は、外科用ツール５（点線で示される）を離脱可能に載せ、そしてＥＣＭ１０は、内視鏡プローブ１１（点線で示される）を離脱可能に載せる。 FIG. 2 shows a perspective view of the telesurgical patient-side system 6 mounted on the cart of FIG. 1 and includes two PSMs 8 and one ECM 10. The cart system 6 includes a column 15 which, in turn, carries three positioning connections or setup arms, two PSM setup arms 7 each supporting one of the PSMs 8 and one setup supporting the ECM 10. Arm 9 is included. Each of the PSM setup arms 7 has six degrees of freedom and is mounted on each side of the ECM setup arm 9 mounted in the center. The ECM setup arm 9 has a severity of less than 6 and the ECM 10 includes all of the tool actuation drive systems provided for articulated surgical instruments, such as those typically included in the PSM 8. It is not necessary. Each PSM 8 removably mounts a surgical tool 5 (shown in dotted lines) and ECM 10 removably mounts an endoscopic probe 11 (shown in dotted lines).
図３Ａおよび３Ｂは、図２のロボット外科用マニピュレーターの連結またはＰＳＭ８のそれぞれ側面図および前面図であり、遠隔中心機構を有する。ＰＳＭ８は、荷車マウント６、天井マウント、または床／台座マウントにより載せられ、そして支持され得るマニピュレーターの１つの先行技術の例である。この例では、ＰＳＭ８は、好ましくは、ツールインターフェースハウジング２１および載せられた器具またはツール５の移動を束縛する連結配列２０を含む。より詳細には、連結２０は、発行された米国特許第６，７５８，８４３号により詳細に記載されるように、ハウジング２１およびツール５が、スペース２２中の点の周りで回転するように平行四辺形配列にある回転ジョイントによって連結される剛直性のリンクを含む。 3A and 3B are a side view and a front view, respectively, of the linkage or PSM 8 of the robotic surgical manipulator of FIG. 2 and having a remote center mechanism. The PSM 8 is one prior art example of a manipulator that can be mounted and supported by a cart mount 6, ceiling mount, or floor / pedestal mount. In this example, the PSM 8 preferably includes a tool interface housing 21 and a linkage arrangement 20 that constrains the movement of the mounted instrument or tool 5. More particularly, the coupling 20 is parallel so that the housing 21 and the tool 5 rotate about a point in the space 22 as described in more detail in issued US Pat. No. 6,758,843. Includes rigid links connected by revolute joints in a quadrilateral array.
連結２０の平行四辺形配列は、その図でページに垂直であり、そして旋回点２２を通過する、しばしば、ピッチ軸と称される軸の周りに、図３Ａ中の矢印２２ａによって示されるような、旋回に回転を束縛する。平行四辺形連結を支持するリンクは、セットアップジョイント（図２中の７）に旋回可能に載せられ、ツール５は、軸２２ｂ（図３Ｂ）の周りでさらに回転し、しばしば、偏揺れ軸と呼ばれる。このピッチ軸および偏揺れ軸は、ツール５のシャフト２３に沿って整列される遠隔中心２２で交差する。ツール５は、なおさらにマニピュレーター８によって支持されるとき、なおさらに駆動される自由度を有し、挿入軸２２ｃに沿ったツールのスライド移動を含む。ツール５は、マニピュレーターインターフェースハウジング２１に載るハウジング２４を含む。インターフェースハウジング２１は、軸２２ｃに沿ったツール５の移動を提供し、そしてＰＳＭ８の端部エフェクターアクチュエーターサーボ機構からツール５にアクチュエーター入力を移行するために供されることの両方を行う。遠隔中心システムのこの例では、平行四辺形配列２０は、ツール５に、サーボ機構が外科医の制御入力に従ってツール移動を作動するとき、ツールシャフト２３を機械的に束縛し、旋回点２２の周りで回転するように連結される。 The parallelogram array of linkages 20 is perpendicular to the page in the figure and passes through pivot point 22, often about an axis referred to as the pitch axis, as shown by arrow 22a in FIG. 3A. , Constraining rotation to turning. The link supporting the parallelogram connection is pivotally mounted on a setup joint (7 in FIG. 2), and the tool 5 rotates further around the axis 22b (FIG. 3B), often referred to as the yaw axis. . This pitch axis and yaw axis intersect at a remote center 22 that is aligned along the shaft 23 of the tool 5. When the tool 5 is still further supported by the manipulator 8, it has a degree of freedom to be further driven and includes sliding movement of the tool along the insertion axis 22c. The tool 5 includes a housing 24 that rests on the manipulator interface housing 21. The interface housing 21 provides both movement of the tool 5 along the axis 22c and serves both to transfer the actuator input from the end effector actuator servomechanism of the PSM 8 to the tool 5. In this example of a remote center system, the parallelogram array 20 causes the tool 5 to mechanically constrain the tool shaft 23 when the servo mechanism actuates the tool movement in accordance with the surgeon's control inputs and around the pivot point 22. Connected to rotate.
ツール５が、マニピュレーター８に対して軸２２ｃに沿ってスライドするとき、遠隔中心２２は、マニピュレーター８の取り付けベース２５（セットアップアーム７への取り付け点）に対して固定されたままである。それ故、全体のマニピュレーター８は、一般に移動して、遠隔中心２２を再位置決めする。マニピュレーター８の連結２０は、一連のモーター２６（図３Ａ）によって駆動される。これらのモーターは、プロセッサー（図１中の４）からの指令に応答して連結２０を能動的に移動する。モーター２６は、ツール５に、軸２２ｃの周りでツール５を回転するようにこのツールにさらに連結され、そして約少なくとも１つ、そしてしばしば２つの自由度でツール５の遠位端でリスト（図４中の２９）を関節運動する。さらに、モーター２６は、鉗子の顎など中に組織を握るためのツールの関節運動可能な端部エフェクターを作動するために用いられ得る。モーター２６は、米国特許第５，７９２，１３５号により詳細に記載されるように、ケーブルを用いてツール５の少なくともいくつかのジョイントに連結され得、この特許の全体の開示はまた、本明細書中に参考として援用される。この参考文献に記載されるように、マニピュレーター８は、しばしば、駆動構成要素からの運動を外科用ツール５に移行するための可撓性部材を含む。内視鏡手順には、マニピュレーター８は、しばしば、カニューレ２７を含む。マニピュレーター８に離脱可能に連結され得るカニューレ２７は、ツール５を支持し、好ましくは、このツールを、カニューレ２７の中心ボアを通って回転および移動させる。 When the tool 5 slides along the axis 22c with respect to the manipulator 8, the remote center 22 remains fixed with respect to the mounting base 25 of the manipulator 8 (the attachment point to the setup arm 7). Therefore, the entire manipulator 8 generally moves to reposition the remote center 22. The connection 20 of the manipulator 8 is driven by a series of motors 26 (FIG. 3A). These motors actively move the link 20 in response to commands from the processor (4 in FIG. 1). The motor 26 is further coupled to the tool 5 to rotate the tool 5 about the axis 22c and is wrist-wound at the distal end of the tool 5 with at least one and often two degrees of freedom (FIG. 29) of 4 is articulated. Further, the motor 26 may be used to actuate an articulatable end effector of a tool for grasping tissue, such as in a jaw of a forceps. The motor 26 may be coupled to at least some joints of the tool 5 using cables, as described in more detail in US Pat. No. 5,792,135, the entire disclosure of which is also described herein. Incorporated in the book as a reference. As described in this reference, the manipulator 8 often includes a flexible member for transferring movement from the drive component to the surgical tool 5. For endoscopic procedures, the manipulator 8 often includes a cannula 27. A cannula 27 that can be releasably connected to the manipulator 8 supports the tool 5 and preferably rotates and moves the tool through the central bore of the cannula 27.
図４は、関節運動する外科用ツールまたは器具５および近位ハウジング２４の展開斜視図を示し、これは、図１のシステムで採用され得る。ツール５は、エフェクター２８を近位ハウジング２４に対して支持する細長いシャフト２３を含む。近位バウジング２４は、マニピュレーター（例えば、図１、２、３Ａ、および３Ｂ中のＰＳＭ８）に器具５を離脱可能に取り付け、そしてそれにインターフェースするため、そしてマニピュレーター８と端部エフェクター２８間で駆動信号および／または運動を伝達するために適合されている。関節運動リスト機構２９は、エフェクター２８とシャフト２３との間で運動の２つの自由度を提供し得、そしてシャフト２３は、端部エフェクター２８に患者の身体内で３つの配向の自由度を提供するように近位ハウジング２４に対して回転可能であり得る。 FIG. 4 shows an exploded perspective view of the articulating surgical tool or instrument 5 and proximal housing 24, which may be employed in the system of FIG. The tool 5 includes an elongated shaft 23 that supports the effector 28 relative to the proximal housing 24. Proximal browsing 24 is a drive signal for releasably attaching and interfacing instrument 5 to a manipulator (eg, PSM 8 in FIGS. 1, 2, 3A, and 3B) and between manipulator 8 and end effector 28. And / or adapted to transmit movement. The articulation wrist mechanism 29 may provide two degrees of freedom of movement between the effector 28 and the shaft 23, and the shaft 23 provides the end effector 28 with three degrees of freedom in the patient's body. As such, it may be rotatable relative to the proximal housing 24.
図５Ａおよび５Ｂをここで参照して、本発明の原理に従って構築された例示のオフセット遠隔中心ロボットマニピュレーター３０の側面図および前面図が示される。以下により詳細に記載されるように、洗練されたマニピュレーター３０は、最小侵襲的ロボット利用手術の間に器具ホルダー３４に連結された外科用器具３２の位置を束縛する、オフセット遠隔中心平行四辺形マニピュレーター連結を提供する。この外科用器具３２は、患者の身体壁中の切開を通る身体腔中への挿入のための形態である遠位作業端部３８を有する細長いシャフト３６を含む。上記の描写は、例示目的のみのためであって、そしてロボット外科用マニピュレーター３０の実際の形状、サイズ、または寸法を必ずしも反映しないことが認識される。これは、本明細書で以後すべての描写に適用する。 Referring now to FIGS. 5A and 5B, there are shown side and front views of an exemplary offset remote central robot manipulator 30 constructed in accordance with the principles of the present invention. As described in more detail below, the sophisticated manipulator 30 is an offset remote center parallelogram manipulator that constrains the position of the surgical instrument 32 coupled to the instrument holder 34 during minimally invasive robotic surgery. Provide concatenation. The surgical instrument 32 includes an elongate shaft 36 having a distal working end 38 that is configured for insertion into a body cavity through an incision in a patient's body wall. It will be appreciated that the above depiction is for illustrative purposes only and does not necessarily reflect the actual shape, size, or dimensions of the robotic surgical manipulator 30. This applies to all depictions hereinafter.
一般に、上記オフセット遠隔中心ロボットマニピュレーター３０は、回転の中心６６に対してシャフト３６の運動を束縛するような形態である。従って、シャフト３６は、シャフト３６が少なくとも１つの自由度で旋回して移動されるとき、回転の中心６６を通って実質的に整列されて維持される。好ましくは、この回転の中心６６は、例えば、腹腔鏡手術の間に腹部壁でトロカールまたはカニューレとともに、内部手術部位への切開点と整列される。従って、外科用器具３２の端部エフェクターは、腹腔壁に対し危険な力を課すことなく、オフセット遠隔中心ロボットマニピュレーター３０を用いてシャフト３６の近位端を移動することにより安全に位置決めされ得る。 Generally, the offset remote central robot manipulator 30 is configured to constrain the movement of the shaft 36 relative to the center of rotation 66. Thus, the shaft 36 is maintained substantially aligned through the center of rotation 66 when the shaft 36 is pivoted and moved with at least one degree of freedom. Preferably, this center of rotation 66 is aligned with the incision point to the internal surgical site, for example with a trocar or cannula at the abdominal wall during laparoscopic surgery. Thus, the end effector of the surgical instrument 32 can be safely positioned by moving the proximal end of the shaft 36 using the offset remote central robot manipulator 30 without imposing a dangerous force on the abdominal wall.
図５Ａを戻って参照し、洗練された遠隔中心マニピュレーターは、一般に、取り付けベース４０を有する関節連結アセンブリ３０、平行四辺形連結ベース４２、および複数のリンク４４、４６およびジョイント４８、５０、５２、５４を含む。用語「ジョイント」は、本明細書中では用語「旋回軸」と交換可能に用いられる。取り付けベース４０は、第１の軸５６の周りの回転のために平行四辺形連結ベース４２に回転可能に連結され、矢印５８によって示されるような偏揺れ軸としてもまた知られる。取り付けベース４０は、外科用マニピュレーター３０が、荷車マウント、天井マウント、床／台座マウント、またはその他の取り付け表面のセットアップアーム／ジョイントによって載せられ、そして支持されることを可能にする。この実施形態における取り付けベース４０は、ねじまたはボルト６２によってベース支持体６０に固定され、ここで、このベース支持体６０は、セットアップアーム／ジョイントに取り付けられるように適合されている。平行四辺形連結ベース４２は、回転旋回ジョイント４８、５０、５２、５４によってともに連結される剛直性リンク４４、４６によって器具ホルダー３４に連結される。これらリンク４４、４６およびジョイント４８、５０、５２、５４は、平行四辺形６４を、器具６４が器具ホルダー３４に載せられ、そしてシャフト３６が平行四辺形６４の平面に沿って移動されるとき、回転の中心６６に対して器具３２の細長いシャフト３６を束縛するように規定する。 Referring back to FIG. 5A, a sophisticated remote center manipulator generally includes an articulation assembly 30 having a mounting base 40, a parallelogram connection base 42, and a plurality of links 44, 46 and joints 48, 50, 52, 54. The term “joint” is used herein interchangeably with the term “swivel axis”. The mounting base 40 is rotatably connected to the parallelogram connection base 42 for rotation about the first axis 56, also known as the yaw axis as indicated by the arrow 58. The mounting base 40 allows the surgical manipulator 30 to be mounted and supported by a setup arm / joint on a cart mount, ceiling mount, floor / pedestal mount, or other mounting surface. The mounting base 40 in this embodiment is secured to the base support 60 by screws or bolts 62, where the base support 60 is adapted to be attached to a setup arm / joint. The parallelogram connection base 42 is connected to the instrument holder 34 by rigid links 44, 46 connected together by rotary swivel joints 48, 50, 52, 54. These links 44, 46 and joints 48, 50, 52, 54 have a parallelogram 64 when the instrument 64 is placed on the instrument holder 34 and the shaft 36 is moved along the plane of the parallelogram 64. The elongated shaft 36 of the instrument 32 is defined to be constrained with respect to the center of rotation 66.
重要なことは、第１の軸５６および平行四辺形６４は、シャフト３６を回転の中心６６で横切る。詳細には、平行四辺形ベース４０の隣接する平行四辺形６４の第１の旋回軸４８から発する第１の辺６８と第１の軸５６は、回転の中心６６でシャフト３６と交差し、ここで、この平行四辺形６４の第１の辺６８と第１の旋回軸４８は、第１の軸５６から角度をなしてオフセットされる。平行四辺形６４の第１の辺６８と第１の旋回軸４８は、少なくとも２゜、好ましくは１０゜だけの角度αだけ第１の軸５６からオフセットされる。一般に、平行四辺形６４の第１の辺６８と第１の旋回軸４８は、第１の軸５６から約２゜から約４５゜までの範囲、好ましくは、約２゜から約３５゜までの範囲でオフセットされる。 Importantly, the first axis 56 and the parallelogram 64 cross the shaft 36 at the center of rotation 66. Specifically, the first side 68 and the first axis 56 emanating from the first pivot axis 48 of the adjacent parallelogram 64 of the parallelogram base 40 intersect the shaft 36 at the center of rotation 66, where Thus, the first side 68 of the parallelogram 64 and the first pivot axis 48 are offset from the first axis 56 at an angle. The first side 68 of the parallelogram 64 and the first pivot axis 48 are offset from the first axis 56 by an angle α of at least 2 °, preferably 10 °. In general, the first side 68 of the parallelogram 64 and the first pivot axis 48 range from about 2 ° to about 45 ° from the first axis 56, preferably from about 2 ° to about 35 °. Offset by range.
ここで、図６Ａおよび６Ｂを参照して、例示のロボットマニピュレーター連結アセンブリ３０のさらなる側面図が示され、器具ホルダー３４を延びた位置で示す。オフセットされた平行四辺形６４配列は、図３Ａおよび３Ｂに記載される先行技術の例に対し、器具３２およびホルダー３４の改善された回転を可能にし、その一方、回転の遠隔中心６６は、同じ位置にある。詳細には、図７Ａ、７Ｂ、８Ａ、８Ｂ、９Ｃおよび９Ｄに示されるように、オフセットされる関節連結アセンブリ３０は、第２の軸（これは、これらの例では、頁に垂直であり、そして旋回点６６を通過する）に対して±５５゜より大きい、好ましくは第２の軸に対して±６０゜より大きい改良された範囲のシャフト３６の移動を提供する。一般に、このオフセットされた関節連結アセンブリ３０は、矢印７２によって示されるように、第２の軸に対して±７５゜からの範囲にある旋回点６６の周りのシャフト３６移動を束縛し、ここで、この第２の軸は、しばしば、ピッチ軸と称される。マニピュレーター３０はまた、図９Ａおよび９Ｂで矢印５８によって示されるように、第１の軸５６に対し±９０゜より大きい、好ましくは、第１の軸５６に対し±９５゜より大きい改良された範囲のシャフト３６移動を提供する。代表的には、片持ちされた平行四辺形連結ベース４２は、旋回点６６の周りのシャフト３６移動を、第１の軸５６に対して±１６８゜からの範囲に束縛する。 With reference now to FIGS. 6A and 6B, a further side view of an exemplary robotic manipulator linkage assembly 30 is shown, showing instrument holder 34 in an extended position. The offset parallelogram 64 array allows improved rotation of the instrument 32 and holder 34 relative to the prior art example described in FIGS. 3A and 3B, while the remote center 66 of rotation is the same. In position. In particular, as shown in FIGS. 7A, 7B, 8A, 8B, 9C and 9D, the articulation assembly 30 to be offset has a second axis (which in these examples is perpendicular to the page; And provides an improved range of movement of the shaft 36 that is greater than ± 55 ° with respect to the pivot point 66), preferably greater than ± 60 ° with respect to the second axis. In general, this offset articulation assembly 30 constrains the movement of the shaft 36 about a pivot point 66 in the range from ± 75 ° relative to the second axis, as indicated by arrow 72, where This second axis is often referred to as the pitch axis. The manipulator 30 also has an improved range of greater than ± 90 ° relative to the first axis 56, preferably greater than ± 95 ° relative to the first axis 56, as indicated by arrows 58 in FIGS. 9A and 9B. Provides movement of the shaft 36. Typically, the cantilevered parallelogram connection base 42 constrains the movement of the shaft 36 about the pivot point 66 to a range from ± 168 ° relative to the first axis 56.
さらに、論議された先行技術と同様に、偏揺れ軸５６、ピッチ軸（頁に垂直である）、および挿入軸７４はすべて、器具３２のシャフト３６に沿って整列される遠隔中心６６で互いと交差する。それ故、器具３２は、回転の遠隔中心６６がマニピュレーター３０の取り付けベース４０（セットアップアーム３０への取り付け点）に対して間隔をあけて固定されたままである間に、矢印５８および７２によって示されるように所望の角度を通って旋回して回転され得る。これ故、全体のマニピュレーター３０は、一般に移動され、遠隔中心６６を再位置決めする。器具３２は、オフセット遠隔中心マニピュレーター３０によって支持されるとき、挿入軸７４に沿った器具のスライドする動きを含む、さらなる駆動される自由度を有することが認識される。 Further, as with the prior art discussed, the yaw axis 56, pitch axis (perpendicular to the page), and insertion axis 74 are all in contact with each other at a remote center 66 aligned along the shaft 36 of the instrument 32. Intersect. Therefore, the instrument 32 is indicated by arrows 58 and 72 while the remote center of rotation 66 remains spaced and fixed relative to the mounting base 40 of the manipulator 30 (the point of attachment to the setup arm 30). Can be swiveled and rotated through a desired angle. Thus, the entire manipulator 30 is generally moved and repositions the remote center 66. It will be appreciated that the instrument 32 has additional driven degrees of freedom when it is supported by the offset remote center manipulator 30, including a sliding movement of the instrument along the insertion axis 74.
偏揺れ軸５６から第１の旋回軸４８および平行四辺形６４の第１の辺６８を外す、新規でかつ改良されたオフセット関節連結アセンブリ３０は、矢印７２によって示されるように、第２の軸に対して旋回点６６の周りの器具３２の移動の範囲を有利に増大する。マニピュレーター３０は、矢印５８によって示されるように、第１の軸５６に対する移動の増加した範囲をさらに可能にする。ピッチ軸および偏揺れ軸に沿った移動の改善された旋回範囲は、次に、このようなロボット手術システムの効率および使用の容易さを増大する。例えば、このロボット手術システムもの全体の複雑さは、システムの改良された範囲の移動に起因して減少され得る。詳細には、セットアップジョイント／アームにおける自由度の数は、低減され得る（例えば、６より少ない自由度）。これは、セットアップジョイントのより少ない予備形態を必要とするより単純なシステムプラットホームを可能にする。従って、通常の手術室作業者は、特殊な訓練をほとんどなく、またそれなくして手術のためのロボットシステムを迅速に整列および準備し得る。 A new and improved offset articulation assembly 30 that removes the first pivot axis 48 and the first side 68 of the parallelogram 64 from the yaw axis 56 is a second axis as indicated by arrow 72. On the other hand, the range of movement of the instrument 32 around the pivot point 66 is advantageously increased. Manipulator 30 further allows an increased range of movement relative to first axis 56, as indicated by arrow 58. The improved swivel range of movement along the pitch and yaw axes in turn increases the efficiency and ease of use of such robotic surgical systems. For example, the overall complexity of this robotic surgical system can be reduced due to the improved range of movement of the system. Specifically, the number of degrees of freedom in the setup joint / arm can be reduced (eg, less than 6 degrees of freedom). This allows for a simpler system platform that requires less preliminary form of the setup joint. Thus, a normal operating room operator can quickly align and prepare a robotic system for surgery with little or no special training.
複数のリンクは、オフセット偏揺れリンク４２、低下垂直リンク４４、および主屈曲リンク４６を備える。この主リンク４６は、垂直リンク４４が主屈曲リンク４６上に静止するための間隔を提供するように所定角度で屈曲される。この間隔は、垂直リンク４４と主屈曲リンク４６との間の連結間衝突を防ぐ。例えば、主リンク４６は、約２２゜の角度で屈曲し得、図８Ａ、８Ｂ、および９Ｄに示されるように、ピッチダイブ７２に亘る間隔を可能にする。このような実施形態では、主屈曲リンク４６および垂直リンク４４ならびに器具ホルダー３４は、同じ平面中に位置される。しかし、主リンク４６および垂直リンク４４は、それに代わって異なる平面（すなわち、横に並んで配置される）でオフセットされ得、屈曲する主リンク４６の代わりに連結間衝突を減少する。垂直リンク４４旋回軸４８は、上記で論議されたように、オフセット平行四辺形６４を提供するように、偏揺れ軸５６に対してより低い。この偏揺れ軸４２は、図９Ｂ〜９Ｄに最も良く観察されるように、リンク４４、４６からオフセットされる。リンク４２およびリンク４４、４６は同じ平面にないが、むしろ、リンク４２と、リンク４４、４６との間の連結間衝突の可能性を減少するように並んでオフセットされる。 The plurality of links includes an offset yaw link 42, a lowered vertical link 44, and a main bent link 46. The main link 46 is bent at a predetermined angle so as to provide a space for the vertical link 44 to rest on the main bent link 46. This spacing prevents a collision between connections between the vertical link 44 and the main flex link 46. For example, the main link 46 may be bent at an angle of approximately 22 °, allowing spacing across the pitch dive 72, as shown in FIGS. 8A, 8B, and 9D. In such an embodiment, the main flex link 46 and the vertical link 44 and the instrument holder 34 are located in the same plane. However, the main link 46 and the vertical link 44 can instead be offset in different planes (i.e., arranged side by side) to reduce inter-collision collisions instead of the bent main link 46. The vertical link 44 pivot axis 48 is lower relative to the yaw axis 56 to provide an offset parallelogram 64, as discussed above. This yaw axis 42 is offset from the links 44, 46 as best seen in FIGS. The link 42 and the links 44, 46 are not in the same plane, but rather are offset side by side to reduce the possibility of an inter-collision collision between the link 42 and the links 44, 46.
回転する旋回軸ジョイント４８、５０、５２、５４によって一緒に連結される剛直性リンク４２、４４、４６の少なくとも１つは、少なくとも１つの自由度で完全に平衡されていない。従って、ブレーキシステムは、関節連結アセンブリ３０に連結され得る。このブレーキシステムは、ジョイント４８、５０、５２、５４の少なくとも１つの関節運動を離脱可能に阻害する。このオフセット遠隔中心マニピュレーター３０は、連結が任意の対抗平衡化重量がないとき、より軽いシステムを備え得る。従って、リンク４２、４４、４６は、好ましくは、より軽いマニピュレーター３０にともなう任意の振動問題を支持するように十分に剛直性であり、そして堅い構造を備え得る。このオフセット遠隔中心マニピュレーター３０は、必要に応じて、重量、張力スプリング、ガススプリング、圧縮スプリング、空気または水力シリンダー、トルクモーター、またはそれらの組み合わせによって平衡され得る。 At least one of the rigid links 42, 44, 46 connected together by the rotating pivot joints 48, 50, 52, 54 is not fully balanced with at least one degree of freedom. Accordingly, the brake system can be coupled to the articulation assembly 30. This braking system removably inhibits at least one articulation of the joints 48, 50, 52, 54. This offset remote center manipulator 30 may comprise a lighter system when the connection is free of any counter balancing weight. Accordingly, the links 42, 44, 46 are preferably sufficiently rigid to support any vibration problems associated with the lighter manipulator 30 and may comprise a rigid structure. The offset remote center manipulator 30 may be balanced by weight, tension spring, gas spring, compression spring, air or hydraulic cylinder, torque motor, or combinations thereof as required.
図６Ｂ、７Ｂ、および８Ｂを戻って参照して、オフセット遠隔中心マニピュレーター３０は、好ましくは、６つのプーリー７６、７８ａ、７８ｂ、８０、８２ａ、８２ｂ、およびこれらプーリー７６、７８ａ、７８ｂ、８０、８２ａ、８２ｂに連結され、回転の中心６６に対してシャフト３６の運動を束縛するような形態である４つの可撓性要素８４ａ、８４ｂ、８６ａ、８６ｂを含み得る。リンク４２および４６は、２つのプーリー７６、７８ａ上で動く可撓性要素８４ａ、８４ｂによって互いに対して回転することから維持され、１つのプーリー７６はリンク４２に固定され、そして１つのプーリー７８ａはリンク４６に固定される。リンク４４および３４は、同様に、残りの４つのプーリー７８ｂ、８０、８２ａ、８２ｂ上で動く可撓性要素８６ａ、８６ｂによって互いに対する回転から維持され、１つのプーリー７８ｂはリンク４４に固定され、１つのプーリー８０はリンク３４に固定され、そしてアイドラープーリー８２ａ、８２ｂは、主屈曲リンク４６の周りに可撓性要素８６ａ、８６ｂを得る。これ故、リンク４２および４６は、転位し得るが、互いに対して回転せず、平行四辺形形状６４を維持する。同様に、リンク４４および３４は転位し得るが、互いに対して回転せず、平行四辺形形状６４を維持する。タームプーリー７６、７８ａ、７８ｂ、８０、８２ａ、８２ｂが、ホイール、ギア、スプロケットなどを含み得ることが認識され得る。 Referring back to FIGS. 6B, 7B, and 8B, the offset remote center manipulator 30 preferably includes six pulleys 76, 78a, 78b, 80, 82a, 82b, and these pulleys 76, 78a, 78b, 80, It may include four flexible elements 84a, 84b, 86a, 86b coupled to 82a, 82b and configured to constrain the movement of the shaft 36 relative to the center of rotation 66. Links 42 and 46 are maintained from rotating relative to each other by flexible elements 84a, 84b moving on two pulleys 76, 78a, one pulley 76 being fixed to link 42 and one pulley 78a being It is fixed to the link 46. The links 44 and 34 are similarly maintained from rotation with respect to each other by the flexible elements 86a, 86b moving on the remaining four pulleys 78b, 80, 82a, 82b, one pulley 78b being fixed to the link 44, One pulley 80 is fixed to the link 34 and idler pulleys 82a, 82b obtain flexible elements 86a, 86b around the main flex link 46. Thus, links 42 and 46 can displace, but do not rotate relative to each other and maintain a parallelogram shape 64. Similarly, links 44 and 34 can displace, but do not rotate relative to each other and maintain a parallelogram shape 64. It can be appreciated that the term pulleys 76, 78a, 78b, 80, 82a, 82b can include wheels, gears, sprockets, and the like.
可撓性要素８４ａ、８４ｂ、８６ａ、８６ｂは、プーリー７６、７８ａ、７８ｂ、８０、８２ａ、８２ｂの周りで連結されるベルト、チェーン、またはケーブルを含み得る。好ましくは、これら可撓性要素は、約８００ポンドの破壊強度有し、そして約１／４インチ幅でいるステンレス鋼ベルトのような、複数層金属ベルトを備える。これらベルトは、少なくとも３つの層、好ましくは５つの層を利用する多層であり、これらプーリーの周りで繰り返し屈曲するとき疲労しないようなお十分に薄く、適切な張力負荷を運ぶに十分に強い。プーリー７６および７８ａは、ほぼ同じ直径、例えば、２．２インチを有する。より小さいプーリー７８ｂおよび８０は、ほぼ同じ直径、例えば、１．８インチを有する。主リンク４６の屈曲には２つのアイドラープーリー８２ａ、８２ｂがあり、ベルト端部の取り付けがより化頑丈であることを可能にするように反対の方向にあるベルト８６ａ、８６ｂの運動を容易にする。非連続オフセットベルト８４ａ、８４ｂおよび８６ａ、８６ｂの採用は、特に、取り付け点におけるストレス減少を提供し、それ故、失敗を最小にする。さらに、非連続ベルトは、便利な張力および位置調節を可能にする。ベルト８４ａ、８４ｂおよびベルト８６ａ、８６ｂが必要に応じて連続的単一ベルトを備え得ることがさらに認識される。さらに、金属ベルトが、マニピュレーターアームに沿って電気的信号を運ぶ平坦な曲げケーブルに軽く連結され得る。 The flexible elements 84a, 84b, 86a, 86b may include belts, chains, or cables that are coupled around pulleys 76, 78a, 78b, 80, 82a, 82b. Preferably, these flexible elements comprise a multi-layer metal belt, such as a stainless steel belt having a breaking strength of about 800 pounds and being about 1/4 inch wide. These belts are multi-layers utilizing at least three layers, preferably five layers, thin enough to not fatigue when repeatedly bent around these pulleys, and strong enough to carry an appropriate tension load. Pulleys 76 and 78a have approximately the same diameter, for example 2.2 inches. Smaller pulleys 78b and 80 have approximately the same diameter, eg, 1.8 inches. The bend of the main link 46 has two idler pulleys 82a, 82b to facilitate movement of the belts 86a, 86b in opposite directions to allow the belt end attachment to be more rugged. . Employment of non-continuous offset belts 84a, 84b and 86a, 86b, in particular, provides stress reduction at the attachment point and therefore minimizes failure. In addition, the non-continuous belt allows convenient tension and position adjustment. It will further be appreciated that the belts 84a, 84b and the belts 86a, 86b may comprise a continuous single belt if desired. In addition, a metal belt can be lightly coupled to a flat bend cable that carries electrical signals along the manipulator arm.
オフセット関節連結アセンブリ３０は、一連のモーターによって駆動される。モーターは、複数のリンク内に位置され得、プーリーおよびベルト機構を駆動する。好ましくは、大部分のモーターは、低下垂直リンク４４中に収容される。特に、スパーギアおよび調和ドライブを通じリンク４２に対してピッチ軸７２回転リンク４４を駆動するモーターおよび器具作動ケーブル（例えば、スプリングで張られ得るリスト駆動ケーブル）を動かすモーターは、リンク４４内に収容され得る。垂直リンク４４、主屈曲リンク４６、および器具ホルダーの同一平面内の配置が、作動ケーブルを動かすモーターがリンク４４中に収容されるので有利である。さらに、同一平面内にある垂直リンク４４、主屈曲リンク４６、および器具ホルダーをもつことは、マニピュレーター３０の遠位端におけるスペース最小化を可能にし、これは、閉じ込められた作動環境で最小侵襲的ロボット手術を実施するとき顕著に重要である。偏揺れ軸５８を駆動するモーターは、取り付けベース４０中に収容され得る。 The offset articulation assembly 30 is driven by a series of motors. The motor can be located in multiple links and drives the pulley and belt mechanism. Preferably, most motors are housed in the lowered vertical link 44. In particular, a motor that drives the pitch shaft 72 rotary link 44 relative to the link 42 through spur gear and harmonic drive and a motor that moves the instrument actuation cable (eg, a wrist drive cable that can be spring loaded) can be housed within the link 44. . The coplanar arrangement of the vertical link 44, the main flex link 46, and the instrument holder is advantageous because the motor that moves the actuation cable is housed in the link 44. Further, having the vertical link 44, the main flex link 46, and the instrument holder in the same plane allows for space minimization at the distal end of the manipulator 30, which is minimally invasive in a confined operating environment. Significantly important when performing robotic surgery. A motor that drives the yaw shaft 58 may be housed in the mounting base 40.
特定の例示の実施形態および方法が、理解の明瞭さ、および例により、ある程度詳細に記載されているが、先行する開示から、このような実施形態および方法のバリエーション、改変、変更、および適合が、本発明の思想および範囲から逸脱することなくなされ得ることは当業者に明らかである。従って、上記の記載は、添付の特許請求の範囲によって規定される本発明の範囲を制限するとして考慮すべきではない。 Although certain exemplary embodiments and methods have been described in some detail by way of clarity of understanding and examples, variations, modifications, changes and adaptations of such embodiments and methods may be made from the preceding disclosure. It will be apparent to those skilled in the art that it may be made without departing from the spirit and scope of the invention. Therefore, the above description should not be taken as limiting the scope of the invention which is defined by the appended claims.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US10/957,077US7594912B2 (en) | 2004-09-30 | 2004-09-30 | Offset remote center manipulator for robotic surgery |
| US10/957,077 | 2004-09-30 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2011115141ADivisionJP5255670B2 (en) | 2004-09-30 | 2011-05-23 | Offset remote center manipulator |
| Publication Number | Publication Date |
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| JP2013135859A JP2013135859A (en) | 2013-07-11 |
| JP5649143B2true JP5649143B2 (en) | 2015-01-07 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2007534622AExpired - LifetimeJP4943338B2 (en) | 2004-09-30 | 2005-09-09 | Offset remote center manipulator |
| JP2011115139AExpired - LifetimeJP5213993B2 (en) | 2004-09-30 | 2011-05-23 | Offset remote center manipulator |
| JP2011115141AExpired - LifetimeJP5255670B2 (en) | 2004-09-30 | 2011-05-23 | Offset remote center manipulator |
| JP2011115140AExpired - LifetimeJP5219226B2 (en) | 2004-09-30 | 2011-05-23 | Offset remote center manipulator |
| JP2012021597AExpired - LifetimeJP5458122B2 (en) | 2004-09-30 | 2012-02-03 | Offset remote center manipulator |
| JP2013020339AExpired - LifetimeJP5649143B2 (en) | 2004-09-30 | 2013-02-05 | Offset remote center manipulator |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2007534622AExpired - LifetimeJP4943338B2 (en) | 2004-09-30 | 2005-09-09 | Offset remote center manipulator |
| JP2011115139AExpired - LifetimeJP5213993B2 (en) | 2004-09-30 | 2011-05-23 | Offset remote center manipulator |
| JP2011115141AExpired - LifetimeJP5255670B2 (en) | 2004-09-30 | 2011-05-23 | Offset remote center manipulator |
| JP2011115140AExpired - LifetimeJP5219226B2 (en) | 2004-09-30 | 2011-05-23 | Offset remote center manipulator |
| JP2012021597AExpired - LifetimeJP5458122B2 (en) | 2004-09-30 | 2012-02-03 | Offset remote center manipulator |
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| US (7) | US7594912B2 (en) |
| EP (6) | EP2253288B1 (en) |
| JP (6) | JP4943338B2 (en) |
| CN (5) | CN105852974B (en) |
| WO (1) | WO2006039092A2 (en) |
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